自控镇静镇痛在胃肠内镜诊疗中的应用_West China Medical Journal

Authors：

宋华勇 ¹ , 张涛 ¹ , 张光信 ¹ ,  王晓 ²

1. ;
2. ;

Corresponding author：

王晓, Email: wangxiao2005_1@hotmail.com

Keywords：

胃肠内镜; 自控镇静镇痛; 个性化用药

DOI：

10.7507/1002-0179.201604215

Video：

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胃肠内镜作为胃肠道疾患的重要诊疗手段，其侵袭性操作所带来的痛苦和紧张焦虑等是妨碍许多患者接受内镜检查的主要原因。实施镇静镇痛会增加患者的耐受性，抵抗焦虑并减少疼痛不适，但同时也增加了心肺系统并发症的风险及检查的费用。因此根据不同患者进行个性化镇静镇痛的自控方式被引入胃肠内镜诊疗的镇静镇痛中，其使用专用的输液泵，通过易于操纵的按钮，由患者自己决定用药时间及药量，体现了按需给药和个体化用药的原则。自控镇静镇痛较传统的镇静镇痛模式可为胃肠内镜诊疗提供更为安全高效的镇静镇痛。

Citation： 宋华勇, 张涛, 张光信, 王晓. 自控镇静镇痛在胃肠内镜诊疗中的应用. West China Medical Journal, 2017, 32(5): 782-785. doi: 10.7507/1002-0179.201604215 Copy

1.	Bynum SA, Davis JL, Green BL, et al. Unwillingness to participate in colorectal cancer screening: examining fears, attitudes, and medical mistrust in an ethnically diverse sample of adults 50 years and older. Am J Health Promot, 2012, 26(5): 295-300.
2.	Green AR, Peters-Lewis A, Percac-Lima S, et al. Barriers to screening colonoscopy for low-income Latino and white patients in an urban community health center. J Gen Intern Med, 2008, 23(6): 834-840.
3.	Arrowsmith JB, Gerstman BB, Fleischer D, et al. Results from the American Society for Gastrointestinal Endoscopy/US Food and Drug Administration collaborative study on complication rates and drug use during gastrointestinal endoscopy. Gastrointest Endosc, 1991(37): 421-427.
4.	Froehlich F, Gonvers JJ, Fried M. Conscious sedation, clinically relevant complications and monitoring of endoscopy: results of a nationwide survey in Switzerland. Endoscopy, 1994, 26(2): 231-234.
5.	Vargo JJ, Niklewski PJ, Williams JL, et al. Patient safety during sedation by anesthesia professionals during routine upper endoscopy and colonoscopy: an analysis of 1. 38 million procedures. Gastrointest Endosc, 2017, 85(1): 101-108.
6.	Khiani VS, Soulos P, Gancayco J, et al. Anesthesiologist involvement in screening colonoscopy: temporal trends and cost implications in the medicare population. Clin Gastroenterol Hepatol, 2012, 10(1): 58-64. e1.
7.	Inadomi JM, Gunnarsson CL, Rizzo JA, et al. Projected increased growth rate of anesthesia professional-delivered sedation for colonoscopy and EGD in the United States: 2009 to 2015. Gastrointest Endosc, 2010, 72(3): 580-586.
8.	Cooper GS, Kou TD, Rex DK. Complications following colonoscopy with anesthesia assistance: a population-based analysis. JAMA Intern Med, 2013, 173(7): 551-556.
9.	Korman LY, Haddad NG, Metz DC, et al. Effect of propofol anesthesia on force application during colonoscopy. Gastrointest Endosc, 2014, 79(4): 657-662.
10.	Adeyemo A, Bannazadeh M, Riggs T, et al. Does sedation type affect colonoscopy perforation rates?. Dis Colon Rectum, 2014, 57(1): 110-114.
11.	Wernli KJ, Brenner AT, Rutter CM, et al. Risks associated with anesthesia services during colonoscopy. Gastroenterology. 2016, 150(4): 888-894, quiz e18.
12.	Radaelli F, Meucci G, Minoli G, et al. Colonoscopy practice in Italy: a prospective survey on behalf of the Italian Association of Hospital Gastroenterologists. Dig Liver Dis, 2008, 40(11): 897-904.
13.	Lee DW, Chan AC, Wong SK, et al. The safety, feasibility, and acceptability of patient-controlled sedation for colonoscopy: prospective study. Hong Kong Med J, 2004, 10(2): 84-88.
14.	Schutz SM, Lee JG, Schmitt CM, et al. Clues to patient dissatisfaction with conscious sedation for colonoscopy. Am J Gastroenterol, 1994, 89(9): 1476-1479.
15.	Agostoni M, Fanti L, Arcidiacono PG, et al. Midazolam and pethidineversus propofol and fentanyl patient controlled sedation/analgesia for upper gastrointestinal tract ultra-sound endoscopy: a prospective randomized controlled trial. Digest Liver Dis, 2007, 39: 1024-1029.
16.	Hwang J, Jeon Y, Park HP, et al. Comparison of alfetanil and ketamine in combination with propofol for patient-controlled sedation during fiberoptic bronchoscopy. Acta Anaesthesiol Scand, 2005, 49(9): 1334-1338.
17.	Mandel JE, Tanner JW, Lichtenstein GR, et al. A randomized, controlled, double-blind trial of patient-controlled sedation with propofol/remifentanilversus midazolam/fentanyl for colonoscopy. Anesth Analg, 2008, 106(2): 434-439, table of contents.
18.	Sümpelmann R, Büsing H, Schröder D, et al. Patient-controlled analgesia with clonidine and piritramide. Anaesthesist, 1996, 45(1): 88-94.
19.	Nilsson A, Folke S, Susanne Ö, et al. Patient-Controlled sedation and analgesia with propofol and alfentanil: a preliminary safety evaluation prior to use of Non-Anaesthesiology doctors. Open J Anesthesiol, 2012, 2: 47-52.
20.	Cook LB, Lockwood GG, Moore CM, et al. True patient-controlled sedation. Anaesthesia, 1993, 48(12): 1039-1044.
21.	Lee DW, Li AC, Ko CW, et al. Use of a variable-stiffness colonoscope decreases the dose of patient-controlled sedation during colonoscopy: a randomized comparison of 3 colonoscopes. Gastrointest Endosc, 2007, 65(3): 424-429.
22.	Sultan SS. Patient-controlled sedation with propofol/remifentanilversus propofol/alfentanil for patients undergoing outpatient colonoscopy, a randomized, controlled double-blind study. Saudi J Anaesth, 2014, 8(Suppl 1): S36-S40.
23.	宋华勇, 李军祥, 刘娟, 等. 瑞芬太尼与异丙酚混合溶液自控镇静镇痛在纤维结肠镜检查中的应用. 世界华人消化杂志, 2014, 22(29): 4519.
24.	Jowell PS, Eisen G, Onken J, et al. Patient-controlled analgesia for conscious sedation during endoscopic retrograde cholangiopancreatography: a randomized controlled trial. Gastrointest Endosc, 1996, 43(5): 490-494.
25.	Külling D, Fantin AC, Biro P, et al. Safer colonoscopy with patient-controlled analgesia and sedation with propofol and alfentanil. Gastrointest Endosc, 2001, 54(1): 1-7.
26.	Roseveare C, Seavell C, Patel P, et al. Patient-controlled sedation with propofol and alfentanil during colonoscopy: a pilot study. Endoscopy, 1998, 30(5): 482-483.
27.	Liu SY, Poon CM, Leung TL, et al. Nurse-administered propofol-alfentanil sedation using a patient-controlled analgesia pump compared with opioid-benzodiazepine sedation for outpatient colonoscopy. Endoscopy, 2009, 41(6): 522-528.
28.	宋华勇, 张涛, 张光信, 等. 瑞芬太尼与丙泊酚混合溶液自控镇痛镇静在老年患者肠镜检查中的应用. 华西医学, 2016, 31(10): 1682-1685.
29.	Russel D. Development of the technology for " Diprifusor” TCI systems. Anaesthesia, 1998, 53(Suppl 1): 22-27.
30.	Gillham MJ, Hutchinson RC, Carter R, et al. Patient-maintained sedation for ERCP with a target-controlled infusion of propofol: a pilot study. Gastrointest Endosc, 2001, 54(1): 14-17.
31.	Mazanikov M, Udd M, Kylänpää L, et al. A randomized comparison of target-controlled propofol infusion and patient-controlled sedation during ERCP. Endoscopy, 2013, 45(11): 915-919.
32.	Goudra BG, Singh PM, Chandrasekhara V. SEDASYS^®, airway, oxygenation, and ventilation: anticipating and managing the challenges. Dig Dis Sci, 2014, 59(5): 920-927.
33.	Goudra BG, Singh PM. SEDASYS, sedation, and the unknown. J Clin Anesth, 2014, 26(4): 334-336.

1. Bynum SA, Davis JL, Green BL, et al. Unwillingness to participate in colorectal cancer screening: examining fears, attitudes, and medical mistrust in an ethnically diverse sample of adults 50 years and older. Am J Health Promot, 2012, 26(5): 295-300.
2. Green AR, Peters-Lewis A, Percac-Lima S, et al. Barriers to screening colonoscopy for low-income Latino and white patients in an urban community health center. J Gen Intern Med, 2008, 23(6): 834-840.
3. Arrowsmith JB, Gerstman BB, Fleischer D, et al. Results from the American Society for Gastrointestinal Endoscopy/US Food and Drug Administration collaborative study on complication rates and drug use during gastrointestinal endoscopy. Gastrointest Endosc, 1991(37): 421-427.
4. Froehlich F, Gonvers JJ, Fried M. Conscious sedation, clinically relevant complications and monitoring of endoscopy: results of a nationwide survey in Switzerland. Endoscopy, 1994, 26(2): 231-234.
5. Vargo JJ, Niklewski PJ, Williams JL, et al. Patient safety during sedation by anesthesia professionals during routine upper endoscopy and colonoscopy: an analysis of 1. 38 million procedures. Gastrointest Endosc, 2017, 85(1): 101-108.
6. Khiani VS, Soulos P, Gancayco J, et al. Anesthesiologist involvement in screening colonoscopy: temporal trends and cost implications in the medicare population. Clin Gastroenterol Hepatol, 2012, 10(1): 58-64. e1.
7. Inadomi JM, Gunnarsson CL, Rizzo JA, et al. Projected increased growth rate of anesthesia professional-delivered sedation for colonoscopy and EGD in the United States: 2009 to 2015. Gastrointest Endosc, 2010, 72(3): 580-586.
8. Cooper GS, Kou TD, Rex DK. Complications following colonoscopy with anesthesia assistance: a population-based analysis. JAMA Intern Med, 2013, 173(7): 551-556.
9. Korman LY, Haddad NG, Metz DC, et al. Effect of propofol anesthesia on force application during colonoscopy. Gastrointest Endosc, 2014, 79(4): 657-662.
10. Adeyemo A, Bannazadeh M, Riggs T, et al. Does sedation type affect colonoscopy perforation rates?. Dis Colon Rectum, 2014, 57(1): 110-114.
11. Wernli KJ, Brenner AT, Rutter CM, et al. Risks associated with anesthesia services during colonoscopy. Gastroenterology. 2016, 150(4): 888-894, quiz e18.
12. Radaelli F, Meucci G, Minoli G, et al. Colonoscopy practice in Italy: a prospective survey on behalf of the Italian Association of Hospital Gastroenterologists. Dig Liver Dis, 2008, 40(11): 897-904.
13. Lee DW, Chan AC, Wong SK, et al. The safety, feasibility, and acceptability of patient-controlled sedation for colonoscopy: prospective study. Hong Kong Med J, 2004, 10(2): 84-88.
14. Schutz SM, Lee JG, Schmitt CM, et al. Clues to patient dissatisfaction with conscious sedation for colonoscopy. Am J Gastroenterol, 1994, 89(9): 1476-1479.
15. Agostoni M, Fanti L, Arcidiacono PG, et al. Midazolam and pethidineversus propofol and fentanyl patient controlled sedation/analgesia for upper gastrointestinal tract ultra-sound endoscopy: a prospective randomized controlled trial. Digest Liver Dis, 2007, 39: 1024-1029.
16. Hwang J, Jeon Y, Park HP, et al. Comparison of alfetanil and ketamine in combination with propofol for patient-controlled sedation during fiberoptic bronchoscopy. Acta Anaesthesiol Scand, 2005, 49(9): 1334-1338.
17. Mandel JE, Tanner JW, Lichtenstein GR, et al. A randomized, controlled, double-blind trial of patient-controlled sedation with propofol/remifentanilversus midazolam/fentanyl for colonoscopy. Anesth Analg, 2008, 106(2): 434-439, table of contents.
18. Sümpelmann R, Büsing H, Schröder D, et al. Patient-controlled analgesia with clonidine and piritramide. Anaesthesist, 1996, 45(1): 88-94.
19. Nilsson A, Folke S, Susanne Ö, et al. Patient-Controlled sedation and analgesia with propofol and alfentanil: a preliminary safety evaluation prior to use of Non-Anaesthesiology doctors. Open J Anesthesiol, 2012, 2: 47-52.
20. Cook LB, Lockwood GG, Moore CM, et al. True patient-controlled sedation. Anaesthesia, 1993, 48(12): 1039-1044.
21. Lee DW, Li AC, Ko CW, et al. Use of a variable-stiffness colonoscope decreases the dose of patient-controlled sedation during colonoscopy: a randomized comparison of 3 colonoscopes. Gastrointest Endosc, 2007, 65(3): 424-429.
22. Sultan SS. Patient-controlled sedation with propofol/remifentanilversus propofol/alfentanil for patients undergoing outpatient colonoscopy, a randomized, controlled double-blind study. Saudi J Anaesth, 2014, 8(Suppl 1): S36-S40.
23. 宋华勇, 李军祥, 刘娟, 等. 瑞芬太尼与异丙酚混合溶液自控镇静镇痛在纤维结肠镜检查中的应用. 世界华人消化杂志, 2014, 22(29): 4519.
24. Jowell PS, Eisen G, Onken J, et al. Patient-controlled analgesia for conscious sedation during endoscopic retrograde cholangiopancreatography: a randomized controlled trial. Gastrointest Endosc, 1996, 43(5): 490-494.
25. Külling D, Fantin AC, Biro P, et al. Safer colonoscopy with patient-controlled analgesia and sedation with propofol and alfentanil. Gastrointest Endosc, 2001, 54(1): 1-7.
26. Roseveare C, Seavell C, Patel P, et al. Patient-controlled sedation with propofol and alfentanil during colonoscopy: a pilot study. Endoscopy, 1998, 30(5): 482-483.
27. Liu SY, Poon CM, Leung TL, et al. Nurse-administered propofol-alfentanil sedation using a patient-controlled analgesia pump compared with opioid-benzodiazepine sedation for outpatient colonoscopy. Endoscopy, 2009, 41(6): 522-528.
28. 宋华勇, 张涛, 张光信, 等. 瑞芬太尼与丙泊酚混合溶液自控镇痛镇静在老年患者肠镜检查中的应用. 华西医学, 2016, 31(10): 1682-1685.
29. Russel D. Development of the technology for " Diprifusor” TCI systems. Anaesthesia, 1998, 53(Suppl 1): 22-27.
30. Gillham MJ, Hutchinson RC, Carter R, et al. Patient-maintained sedation for ERCP with a target-controlled infusion of propofol: a pilot study. Gastrointest Endosc, 2001, 54(1): 14-17.
31. Mazanikov M, Udd M, Kylänpää L, et al. A randomized comparison of target-controlled propofol infusion and patient-controlled sedation during ERCP. Endoscopy, 2013, 45(11): 915-919.
32. Goudra BG, Singh PM, Chandrasekhara V. SEDASYS^®, airway, oxygenation, and ventilation: anticipating and managing the challenges. Dig Dis Sci, 2014, 59(5): 920-927.
33. Goudra BG, Singh PM. SEDASYS, sedation, and the unknown. J Clin Anesth, 2014, 26(4): 334-336.

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自控镇静镇痛在胃肠内镜诊疗中的应用

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